The literature search for each section was based on a search of Medline and PubMed for the years since the previous Lancet Seminars on this topic (2000 and 2005) and 2009 inclusive. We searched for English language articles only, using the keywords “carcinoma, non-small cell” and the specific terms used in the title of each section. Additional references were taken from review articles and the individual authors' own publications.
SeminarNon-small-cell lung cancer
Section snippets
Advances in pathology
The last Lancet Seminar on non-small-cell lung cancer (NSCLC) was published in 2000, with no mention of the advancing molecular age,1 and although the 2004 WHO classification of lung tumours introduced relevant genetic data,2 rapid development in this area has necessitated an almost immediate update, specifically relating to adenocarcinoma and diagnosis on the basis of biopsies and cytological material.3 A key aspect of this recent update was the multidisciplinary and international composition
Advances in early diagnosis
Routine screening for lung cancer is not currently recommended by any major medical organisation. Several phase 2 non-randomised trials of CT screening of high-risk individuals (current or former smokers with 20 pack-years of smoking) have yielded enticing results.20, 21, 22 They have shown that CT screening detects small-sized lung cancers of 12–15 mm in diameter. Chest radiographs have been shown to miss 70–80% of the cancers that are detected by CT. In prevalence studies, 60–80% of detected
Prognostic factors
The assessment of prognosis is an important factor affecting the selection of appropriate treatment for each individual case. The variables that are associated with prognosis can be grouped into categories: tumour-related, such as primary site, cell type, and extent of disease; patient-related, such as performance status, comorbidity, and sex; and environmental factors, such as nutrition and the choice and quality of treatment.40 These variables can be useful individually or combined to form a
Advances in surgical treatment
Technological advances and knowledge generated from clinical trials continue to improve our understanding of the role of surgery in staging, selection, and surgical management of patients with lung cancer. Mediastinoscopy and mediastinal lymph-node biopsy was widely done for the diagnosis and staging of lung cancer, but with increasing availability and use of PET and PET/CT, mediastinoscopy became reserved to screening for false-positive results on PET so as not to deny suitable patients the
Advances in chemotherapy in adjuvant, induction, and multimodal settings
Despite optimum surgical management, the 5-year survival rate of resected NSCLC ranges from 25% to 73% according to pathological stage. In a meta-analysis72 published in 1995, a 13% reduction in the risk of death was reported, suggesting an absolute benefit of 5% at 5 years with adjuvant chemotherapy.72 These results constituted the rationale for a new generation of randomised studies with platin-based regimens.73, 74, 75, 76, 77, 78
The LACE meta-analysis79 pooled 4584 patients accrued in five
First-line treatment
Chemotherapy remains the mainstay of treatment for advanced stage IIIB and IV NSCLC (table 2).92, 93, 94, 95, 96, 97, 98 A platinum-based doublet is recommended for fit patients, and single agents can be offered in elderly patients or poor performance subsets.99, 100 Selection of therapy was not based on histological subtype until recently, when the multitargeted antifolate agent pemetrexed was shown to be less active in patients with squamous cancers than in other types of disease; approval of
Advances in radiotherapy
Radiotherapy has important roles in both curative and palliative treatment of NSCLC. An estimated 75% of patients with NSCLC might benefit from radiotherapy.116 Recent advances in radiotherapy for NSCLC have been more strongly affected by developments in technology than by an improved understanding of the radiobiology of the disease.
Curative radiotherapy might be indicated in patients with good performance status (Eastern Cooperative Oncology Group status 0–1) and inoperable disease localised
Search strategy and selection criteria
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J Thorac Oncol
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J Thorac Oncol
The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathological TNM stage in surgically managed non-small cell lung cancer
J Thorac Oncol
Primary tumour standardized uptake value (SUV max) measured on fluorodeoxyglucose emission tomography (PDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project
J Thorac Oncol
Video-assisted thoracoscopic versus open thoracotomy lobectomy in a cohort of 13,619 patients
Ann Thorac Surg
A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer
Lung Cancer
Phase III study comparing chemotherapy and radiotherapy with preoperative chemotherapy and surgical resection in patients with non-small-cell lung cancer with spread to mediastinal lymph nodes (N2); final report of RTOG 89-01. Radiation Therapy Oncology Group
Int J Radiat Oncol Biol Phys
Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial
Lancet
Pneumonectomy is a valuable treatment option after neoadjuvant therapy for stage III non-small-cell lung cancer
J Thorac Cardiovasc Surg
Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB–IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): a randomised controlled trial
Lancet Oncol
Preoperative chemotherapy in patients with resectable non-small cell lung cancer: results of the MRC LU22/NVALT 2/EORTC 08012 multicentre randomised trial and update of systematic review
Lancet
Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-small cell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients
Ann Oncol
Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study
Lancet
Gefitinib versus docetaxel in previously treated non-small-cell lung cancer (INTEREST): a randomised phase III trial
Lancet
Recent issues in first-line treatment of advanced non-small-cell lung cancer: results of an International Expert Panel Meeting of the Italian Association of Thoracic Oncology
Lung Cancer
Tumours of the lung, pleura, thymus and heart
The diagnostic value of TTF-1, CK 5/6, and p63 immunostaining in classification of lung carcinomas
Appl Immunohistochem Mol Morphol
p63 and TTF-1 immunostaining. A useful marker panel for distinguishing small cell carcinoma of lung from poorly differentiated squamous cell carcinoma of lung
Am J Clin Pathol
A comparison of survival and disease-specific survival in surgically resected, lymph node-positive bronchioloalveolar carcinoma versus nonsmall cell lung cancer: implications for adjuvant therapy
Cancer
Invasive size is an independent predictor of survival in pulmonary adenocarcinoma
Am J Surg Pathol
Micropapillary pattern: a distinct pathological marker to subclassify tumours with a significantly poor prognosis within small peripheral lung adenocarcinoma (</=20 mm) with mixed bronchioloalveolar and invasive subtypes (Noguchi's type C tumours)
Histopathology
A grading system of lung adenocarcinomas based on histologic pattern is predictive of disease recurrence in stage I tumors
Am J Surg Pathol
Lung adenocarcinoma: modification of the 2004 WHO mixed subtype to include the major histologic subtype suggests correlations between papillary and micropapillary adenocarcinoma subtypes, EGFR mutations and gene expression analysis
Am J Surg Pathol
Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK
J Clin Oncol
TNM classification of malignant tumours
Comprehensive histologic assessment helps to differentiate multiple lung primary nonsmall cell carcinomas from metastases
Am J Surg Pathol
CT screening for lung cancer: five-year prospective experience
Radiology
Survival of patients with stage I lung cancer detected on CT screening
N Engl J Med
Computed tomography screening and lung cancer outcomes
JAMA
A randomized study of lung cancer screening with spiral computed tomography
Am J Respir Crit Care Med
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